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- W4241805305 abstract "Comment The authors of this paper wish to explore the possible clinical advantages that might be taken of the pharmacokinetic differences of the two enantiomers of bupivacaine (levo-and dextro-rotatory). This is a fascinating approach that has application for local anesthetics, muscle relaxants, and, perhaps, other drugs used in anesthesiology. One enantiomer might be more toxic, whereas the other may have a greater share of clinical effect. This study used data obtained from 12 patients after orthotopic liver transplantation who were given bilateral intercostal nerve blocks for postoperative analgesia. The study was concluded after 2 of the 12 patients sustained major complications directly related to the study. One developed grand mal seizures after 2.3 mg/kg bupivacaine (0.5% with 1:400,000 epinephrine). The second patient developed a pneumothorax after the intercostal block was performed by “a relatively inexperienced operator.” Unfortunately, there is no mention of clinical variables in the 12 patients other than the authors' opinion that after liver transplantation patients have hepatic dysfunction. Increased cardiac output, decreased systemic vascular resistance, and arteriovenous shunting persist in the liver transplant patient. Ascites will reaccumulate if this has been a preoperative problem. If the allograft is dysfunctional, coagulopathy is on-going, necessitating massive fluid infusion. This seems to be a poor setting in which to establish pharmacokinetic differences between enantiomers of bupivacaine." @default.
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- W4241805305 date "1996-04-01" @default.
- W4241805305 modified "2023-10-14" @default.
- W4241805305 title "Bupivacaine Enantiomer Pharmacokinetics After Intercostal Neural Blockade in Liver Transplantation Patients" @default.
- W4241805305 doi "https://doi.org/10.1097/00132586-199604000-00054" @default.
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